Fractional laser: is there risk for worsened old self-harm scars? (Photo)

Question

I am considering getting my 10 years old self-harm scars removed. They are not that big and have faded nicely, but some of them are raised (hypertrophic). I have met with a dermatologist and she recommended fractional laser (Fraxel). To me, it sounds counterintuitive that boosting collagen production may reverse the scars. Is there a risk of the scars getting more raised/apparent from the laser?

Raffy Karamanoukian, MD, FACS · Answer

Our treatments use combination therapy to improve the epidermis and dermis for most deep scars. The options available for acne scars depend on the character of your scars, in terms of topography and contour. We see atrophic and hypertrophic acne scars, as well as scars that have hypo and hyperpigmentation. We begin each scar evaluation with an assessment of scar quality and subtype. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to decide whether early subcision should be started.

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Nelson Lee Novick, MD · Answer

If the scar is raised (I.e, hypertrophic or keloidal), it needs to be flattened and that typically requires intralesional injections of certain anti-inflammatory agents.
If the scar is indented (I.e, atrophic), it needs to be elevated and smoothed and that typically can be done with simple subcision.
If the scar is hypopigmented and with superficial texture irregularities, it needs to blended batter, which can be done via manual microneedling (no need for the added expense and risks of RF microneedling) accompanied by the application of Rx pigment enhancing topicals. 
Notice that I did not once mention the use of expensive, bells and whistles devices, such as fraxel lasers whose hard science to back up its use lags well behind the heavy marketing hype and social media buzz to promote them.
Make sure to consult and experienced, board certified cosmetic dermatologist scar treatment specialist.
Hope this helps and best of luck.

Fractional laser: is there risk for worsened old self-harm scars? (Photo)

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Fractional laser: is there risk for worsened old self-harm scars? (Photo)

Answers (2)

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Everything you need to know about Laser Scar Removal

Our mission is to create a world where every investment in modern beauty is Worth It.